Orthopedic apparatus for use with image intensification equipment

ABSTRACT

In surgical procedures in which unilateral traction is applied to the appropriate lower extremity to immobilize the pelvis against a perineal post and an iliac post, and in which image intensification techniques are used, the iliac post is adjusted relative to the perineal post and in a direction parallel to the mesial plane according to the length of the pelvis. Tube-locating means movable with the iliac post in fixed mesial relation therewith determine the position of the intensifier tube under the patient. The foot or leg traction unit and the well leg support are carried by arms mounted on and extending outwardly from the perineal post above the patient, without obstructing access of the intensifier tube to the body of the patient. The vertical moment on the post due to the weight of these extended parts is absorbed by an arm or arms extending inwardly from the perineal post above the patient to a fixed point of support.

United States Patent William Sidney Watson Pittsford, N.Y.

Dec. 30, 1969 Nov. 30, 1971 The Pelvic Anchor Corporation Rochester, N.Y.

inventor Appl. No. Filed Patented Assignee ORTHOPEDIC APPARATUS FOR USE WITH IMAGE INTENSIFICATION EQUIPMENT 7 Claims, 8 Drawing Figs.

References Cited UNITED STATES PATENTS 10/1954 Watson 128/84 B Primary ExaminerAnth0ny L. Birch Attorney-Cameron, Kerkam & Sutton ABSTRACT: In surgical procedures in which unilateral traction is applied to the appropriate lower extremity to immobilize the pelvis against a perineal post and an iliac post, and in which image intensification techniques are used, the iliac post is adjusted relative to the perineal post and in a direction parallel to the mesial plane according to the length of the pelvis. Tube-locating means movable with the iliac post in fixed mesial relation therewith determine the position of the intensifier tube under the patient. The foot or leg traction unit and the well leg support are carried by arms mounted on and extending outwardly from the perineal post above the patient, without obstructing access of the intensifier tube to the body of the patient. The vertical moment on the post due to the weight of these extended parts is absorbed by an arm or arms extending inwardly from the perineal post above the patient to a fixed point of support.

PATENTEUuuvsouan 1624.396

mvmwon WILLIAM S. WATSON av aflwzoig ziam 655M200 ATTORNEYS PATENTEU NUV30 Ian SHEET 2 OF 3 mvnmon WILLIAM S. WATSON BY fa mam/gm? & 5113200 ATTORNEYS BACKGROUND OF THE INVENTION This invention relates to orthopedic apparatus useful in surgical procedures for the treatment of hip injuries, in which image intensification techniques are used.

In my prior patent, U.S. Pat. No. 2,69l,979,a sacral rest is disclosed which includes a pelvic support together with a perineal post and two iliac posts. Either side of the pelvis can be immobilized on the pelvic support by the application of unilateral traction to the appropriate lower extremity so that the pelvic structure of that side is held fixed against the perineal and iliac posts and twisting or other movement of the pelvis which might interfere with the desired treatment is prevented. This apparatus has the important advantages of firmly and securely immobilizing the pelvis and thus contributing to the success of the operation, and also it eliminates the need for bilateral traction. In my prior patent, U.S. Pat. No. 3,090,381,the principles of the invention of U.S. Pat. No. 2,691 ,979,are embodied in accessory apparatus to be used on operating tables including a special base for positioning the patient with an injured hip exposed over the edge of the table where it is readily accessible to the surgeon.

The spacing between the posts in such apparatus must be capable of variation in order to accommodate pelvic structures of varying sizes, as for example, in cases of children as compared with adults. In apparatus such as exemplified by said prior patents adjustments for the length of the pelvis are provided by mounting the perineal post so that it can be moved in the mesial direction relative to the iliac posts and locked in adjusted position. The iliac posts are similarly mounted for movement in a lateral direction at right angles to the mesial line and can be locked in a position corresponding to the width of the pelvis, so as to engage the ilium when unilateral traction is applied to a lower extremity.

In reduction of hip fractures, fractures of the leg bones, and like operations, image intensification techniques have recently been found to be of great value. An intensifier tube including a camera of known construction is located close to the critical area and is activated by an X-ray beam and connected either with a fluoroscopic screen or with a television circuit, or both. Thus, the surgeon can view the operating site and the fluoroscopic image practically simultaneously, which is of great value and assistance to him in the course of the operation. At the same time the progress of the operation can be observed on the screen by others in the operating theater and can be followed and studied on remote television screens.

Usually the image intensification unit is made portable so that it can be moved readily out of the way when not in use or from one place to another so as to approach the body of a patient on an operating table from various angles. This unit is mounted on a wheeled frame, and a vertically adjustable column on this frame carries at its head a laterally movable horizontal support which in turn carries slidably a circular arm of 180 of are (sometimes called the C-arm). The X-ray tube or generator is mounted at one end of this arm and the intensifier tube at the other so that they are diametrically opposite one another with the X-ray beam aimed directly at the center of the screen of the intensifier tube. By sliding the arc in its support the direction of this X-ray beam may be adjusted between vertical and horizontal, but the X-ray tube and the intensifier tube always remain diametrically opposite one another.

One of the problems in the use of such image intensification equipment arises from the need for locating the intensifier tube accurately, first so that the X-ray beam passes directly through the critical site to be examined, and second so that the tube screen is at the proper distance from the critical site in order to obtain good results in the magnified image produced by the tube. It is important to minimize interference with the free movement of the intensifier tube to and from the body of the patient, such as might be caused by leg supports, leg traction units, and the like. Also it is often a matter of considerable difficulty to locate the tube properly with reference to the critical site, in spite of freedom of access to it, because the tube itself is under the table or support, or is hidden by the necessary draping of the patient on the table, so that it cannot readily be observed.

SUMMARY OF INVENTION According to the present invention. similar to that disclosed in my prior U.S. Pat. No. 3,090,381 is designed and constructed to provide for accurate positioning of the intensifier tube relative to the critical site, regardless of necessary adjustments of the apparatus to correspond with the dimensions of the pelvis, and in spite of the fact that the tube itself may not be visible to the surgeon or his assistants. To these ends the iliac post or posts are mounted not only for lateral adjustment according to the width of the pelvis, but also for adjustment in the mesial direction according to the length of the pelvis, the perineal post being stationary. Tubelocating stops in fixed mesial relation to the iliac posts are arranged to project downwardly below the table or support and preferably to provide a sort of corner near each iliac post into which the end of the intensifier tube can be moved until it comes into peripheral contact with the stops. Thus without visual observation the tube can be located accurately relative to either iliac post. In order to maintain this fixed relationship, the stops are mounted for movement with the iliac posts at least in the mesial direction.

In order to minimize obstruction of access of the tube to the body of the patient, the traction apparatus and the usual sup port for the well leg are carried by supporting arms mounted on the perineal post and extending outwardly therefrom at a level well above the table or pelvic support. Thus they do not interfere with movement of the intensifier tube into the desired position beneath the body of the patient. Preferably the vertical moment due to the weight of these parts is absorbed by an arm or brace extending inwardly from the upper end of the perineal post to a suitable point of fixed connection with the table or pelvic support.

These results are accomplished by means of a table or support generally similar to that disclosed in my prior U.S Pat. No. 3,090,381 and adapted for use on surgical or orthopedic tables simply by removing the usual pads, cushions and the like and securing the pelvic support on top of the surgical or orthopedic table. For example, the pelvic support can be provided with tongues or ribs slidable in the grooves used for mounting leg boards in one well-known type of orthopedic table, or can be provided with suitable clamps for attachment to the side rails usually provided on surgical tables. Preferably both means of attachment are provided so that the pelvic sup port can be used interchangeably on either type of table.

orthopedic apparatus BRIEF DESCRIPTION OF THE DRAWINGS One embodiment of the invention is illustrated by way of example in the accompanying drawings but it will be understood that the invention is not restricted to this embodiment and is capable of variations in the form and details of the parts.

In said drawings,

FIG. I is a perspective view illustrating apparatus embodying the invention in use on a surgical table of known type, with image intensification equipment shown in dotted lines in two positions;

FIG. 2 is a perspective view illustrating apparatus embodying the invention as seen from the top;

FIG. 3 illustrates the apparatus of FIG. 2 in perspective as seen from the bottom;

FIG. 4 is a view similar to FIG. 3 but in section on the middle line of the equipment;

FIG. 5 is a plan view of the table shown in FIG. 1 with apparatus embodying the invention in place thereon;

FIG. 6 is a perspective detail which illustrates how the apparatus embodying the invention is attached to the table of FIGS. 1 and 5;

FIG. 7 shows an elevatable support which is part of another operating table of known type on which the apparatus of FIGS. 2, 3, and 4 can be used, part of said apparatus being shown in section to illustrate the mounting of said apparatus on said elevatable support; and

FIG. 8 is a perspective view showing details of the connection between the apparatus and support shown in FIG. 7.

DESCRIPTION OF PREFERRED EMBODIMENT FIG. 1 shows a surgical table of well-known type which is made mobile by mounting it on a carriage 1 provided with suitable casters 2. On this carriage is a suitable motor 3, preferably electric, which can be used to manipulate the various sections of the table so as to support the body of the patient in various positions. The motor controls include for example foot pedals 4 and manual conu'ols 5. The table itself comprises a number of articulated sections including a head section 6, here shown turned down; a back section 7 and a seat section 8 here shown in the same plane; and a foot section 9 which like the head rest 6 is shown turned down. It should be understood that the details thus far described are not part of the present invention and are illustrated only as a means of showing the use of equipment embodying the present invention when placed on top of the back section 7 and seat section 8 as hereinafter described in greater detail.

Referring to FIGS. 2 and 3, equipment embodying the invention comprises a base 10 arranged to be mounted on top of a surgical table such as described above and to support the back and preferably also the head of a patient. This base 10 is provided with side rails 11 along both sides thereof, the side rails being mounted on the base by means of any suitable type of bracket 12 by which the rails are supported in spaced relationship with the edges of the base itself. These side rails provide means for mounting accessory equipment which may be required in the course of an operation.

At one end the base 10 is narrowed down to form an extension 13, the end of which terminates in a V-shaped notch 14 for a purpose to be described. On each tip of the V-shaped notch suitable provision is made for mounting a perineal post such as described above, the post being mounted either on the left-hand side or the righthand side depending on the site of the injury to be treated. For example, when perineal posts of the type shown in FIG. 10 of U.S. Pat. No. 2,691,97'3 are employed, undercut slots 15 are provided in these tips, the inward end of each slot being enlarged as shown at 16 whereby to allow the head of a securing bolt to be inserted as described in the aforesaid prior patent. It will be understood that on the application of traction to the injured leg, the perineal post will be held against the outer end of the slot 15.

As already explained, in order to accommodate pelvic structures of different sizes, the iliac posts are arranged for adjustability both laterally and also in the mesial direction. As shown in FIGS. 2 and 3, two auxiliary supports 17 are provided, one on each side of the narrow extension 13 of the base 10. These auxiliary supports 17 are capable of movement as a unit relative to the base in the mesial direction as will be described. Each auxiliary support 17 is also provided with an undercut slot 18 which is open at the outer end of the auxiliary support so that iliac posts such as described in my prior patents referred to above can be inserted in these slots and moved inwardly therein to a position of lateral adjustment which conforms to the width of the pelvis in any given case.

To provide for adjustment of the iliac posts in the mesial direction, the auxiliary supports 17 are connected together and suitably mounted on the base structure 10, 13 for unitary movement. FIG. 3 shows bars 19 extending substantially the entire length of the structure 10, 13 and secured thereto in any suitable manner in spaced parallel relationship on the two sides of the mesial line. Each bar 19, at the section thereof which underlies the base extension 13, is notched at two points as shown at 20 to provide openings between the bar and the bottom surface of the extension 13 in which transversely extending parallel bars 21 are movable in the mesial direction.

Preferably these bars 21 are of the same height as the bars 19, but are mortised to receive the notched portions of the bars 19 in slidable fashion. The transverse bars 21 are connected together by longitudinal bars 22 to form an integral framework which, because of the notched or mortised arrangement already described, is capable of unitary movement in the mesial direction.

The ends of the inner transverse bar 21 extend outwardly on both sides of the base extension 13 and carry the auxiliary supports 17 already described. Accordingly the mesially movable unit comprising the transverse bars 21, the longitudinal bars 22 and the auxiliary supports 17 support the iliac posts and provide for adjustment thereof relative to the perineal posts in the mesial direction.

Referring again to FIG. 1, the patient is shown in position for an operation of the left hip. The perineal post 23 is accordingly positioned on the left-hand tip of the extension 13,

and the iliac post 24 is mounted on the left-hand auxiliary support 17 so that the left hip of the patient is exposed and accessible at the edge of the base extension 13. The left leg of the patient is placed in traction by suitable means such as a foot pad 25 and a traction device 26 operated manually by means of a handwheel 27. In order not to interfere with the access of the intensifier tube, these traction parts are preferably carried by a post 28 depending from an extensible arm 29 which is pivotally mounted in the upper end of the perineal post 23 and extends outwardly from the table at a level above the body of the patient. The right leg of the patient is supported out of the way by an elevated leg board 30 carried by a supporting structure 31. Posts 32 support the structure 31 on the end of an arm 33 which is also pivotally mounted in the upper end of the perineal post 23. Preferably the angle between arms 29 and 33 is set by means of an arm 3d extending from the arm 33 to a suitable adjustable connection with the arm 29.

Because the weight of both the injured leg and the well leg, and the weight of the traction apparatus and leg supporting means as well, exert an overturning moment in a vertical plane on the perineal post, it is desirable to counteract this moment by a brace 35, which may be an extension of the arm 33, which extends from the perineal post inwardly above the body of the patient to an elevated transverse rod 36 having downturned ends 37 that are secured by suitable clamps 38 to the side rails 11. It will be observed that the position of the arm 33 and brace 35 will vary depending on whether the right or left leg of the patient is being treated. As shown, with the perineal post located for treatment of the left hip, the inner end of the brace 35 is attached to the crossarm 36 at a point to the right of the center line of the apparatus as seen in FIG. 1. in case the right hip were injured, the perineal post would be mounted on the right-hand tip of the support extension 13 and the point of connection of the brace 35 to the transverse arm 36 would be shifted toward the other side of the apparatus. Any suitable adjustable clamps can be provided to make an adjustable connection at 39 between brace 35 and crossarm 36 to permit this shift, or connections at fixed points can be provided by means such as a pin and aligned holes. A single hole in the crossarm 36 can be used, in which case it would be necessary to disengage the clamps 38 and reverse the position of the crossarm assembly 36, 37, in order to shift from the left to the right hip or vice versa.

It will be apparent that the crossarm 36 can be used as an anesthetic screen or for any other desired purpose. In FIG. I, for example, it serves to anchor the left arm of the patient out of the way.

FIG. 1 shows in dotted lines two positions of a typical intensifier tube and TV camera unit, one in which the unit is located beneath the injured left hip and is aimed vertically upward as indicated at 40 and the other in which the unit is aimed horizontally at the injured hip as indicated at 40. ln the latter case, the end of the tube is brought under the elevated well leg and close to the site of the operation by bringing it into or nearly into contact with one of the edges of the V- notch in the end of the extension 13.

in the case of the tube position shown tioning is difficult first because the tube is underneath the support and the injured leg of the patient, and second because it is concealed to a large extent by the draping of the patient (not shown) that is necessary in order to provide a sterile area for the operation. Referring back to FIG. 3, it will be observed that the transverse bar 21 which carries the auxiliary supports 17, and the longitudinal frame bars 22 which is part of the movable unit carrying the iliac posts, form depending rectangular corners under both the left hip and the right hip of the patient. With this arrangement, therefore, it is only necessary to move the mobile tube unit 40 until the periphery of the tube is brought into contact with the frame bars 21 and 22 and is accurately positioned in the comer formed by these bars. it will be observed that this docking comer 21, 22 is at all times in the same fixed relationship, mesially speaking, with the iliac post so that the tube is automatically and precisely located relative to the injured hip even though the tube itself is not visible.

in order to mount the apparatus of FIGS. 2 and 3 on the surgical table as shown in FIG. 1, any suitable means can be employed such as those illustrated in my prior U.S. Pat. No. 3,090,381. Preferably, however, the present invention includes novel means for placing the support securely in the desired position. This is accomplished by taking advantage of the usual side rails 41 which are mounted in spaced parallel relation with the edges of the table by suitable spacers 42 located at intervals along the length of the table. The normal spacing between such side rails and the edges of the table is sufi'rcient for depending hooks 43, mounted on the brackets 12 as shown in FIG. 3, to be inserted between the side rails and the table edges (see FIG. 6) and to be hooked over appropriate spacers. Then the forward end of the support is lowered until the whole support is horizontal, which causes suitable stops 44, also mounted on brackets 12 and located near the forward end of the main base 10, to drop over additional spacers, thereby positioning the base table as shown in F 1G. 5 and locking it securely with regard to horizontal movement. Any desired number of such hooks can be provided, but usually one pair will be sufficient, especially where two or more forward stops are provided for engagement with differently located spacers.

in other types of tables, such as an orthopedic table of the type illustrated in FIG. 13 of my prior U.S. Pat. No. 2,691,979, a vertically elevatable rack bar in included which is arranged to carry at its top demountable supporting boards for the body of the patient. FIGS. 4, 7 and 8 illustrate how such apparatus can be used for mounting the support embodying the present invention as described above. By way of example, the rack bar 45 (FIG. 7) carries at its upper end a structure built up of top and bottom plates 46 and intermediate front and rear end blocks 47 (the front end blocks only being shown in FIG. 7). The top and bottom plates being wider than the blocks, this structure provides groovelike sides into which body support boards are usually fitted and pushed against stops 48 at the rear end of the structure.

The apparatus of the present invention can easily be adapted for use with such a construction by spacing the frame bars 19 apart by a distance equal to the width of the top plate, and by securing on the inner sides of these frame bars riblike members 49 which are spaced from the underneath surface of the main base by a distance approximately equal to the thickness of the top plate. With this arrangement, accordingly, the apparatus or device of the present invention can be pushed onto the supporting structure in the position shown in FIG. 7. The underneath surface of the base 10 rests on the top plate 46 and the frame bars 19 (only one is shown) extend downwardly and fairly closely embrace the edges of both the top and bottom plates 46. The ribs 49 (only one is shown) are located between the outer edges of the top and bottom plates. The height of these members 49 is preferably such that they fit snugly between the top and bottom plates.

When the device of the present invention is moved completely into position as described, the snug fit of the ribs at 40, accurate posi- 49 between the top and bottom plates 46 as well as the close embrace of the edges of the top and bottom plates 46 by the longitudinal bars 19 provide for adequate and stable support of the device and also of the weight of the patients body, without the need for auxiliary supports such as the locking bar 51 normally provided for securing leg boards and the like. Movement of the device onto the support structure is limited when it engages the stops 48, one on each side of the support structure. Preferably the ends of the bars 19 may be notched as shown at 50 in FIG. 8 so as to embrace the stop plates 48. FIG. 8 also shows a notch 52 cut into the bar 19 and its associated rib 49. This may be desirable when the device is used on a table of the type shown in FIG. 5 wherein the back section 7 and the seat section 8 are separated by a bridging member 53 as shown in dotted lines. As known in the art, such bridging members often are curved and project somewhat above the plane of the back and seat sections, in which event the upward projection is accommodated by the notch 52.

It will be evident that the objectives of the invention with regard to access of the intensifier tube to the desired operating site, and of accurate location of the intensifier tube even though practically concealed from the eyes of the surgeon, are secured with the orthopedic table of the type shown in part in FIG. 7 as well as by surgical tables as described in connection with FIG. 1.

I claim:

1. Apparatus for use with a portable intensifier tube for the treatment of hip injuries and the like and comprising a pelvic support having a perineal post for restraining the pelvis against movement in the mesial direction and an iliac post for restraining it against transverse movement and capable of lateral adjustment according to the width of the pelvis, in which the improvement comprises means mounting said iliac post on said support for movement in the mesial direction relative to said perineal post to a position corresponding with the length of the pelvis, and intensifier tube locating means fixed to and projecting below said mounting means and movable mesially with said iliac post.

2. Apparatus as defined in claim 1, including a supporting arm mounted on said perineal post and extending outwardly therefrom at a level above said pelvic support, a leg traction device depending from said arm at a point remote from said support, and a brace connected to said perineal post and extending therefrom in a direction approximately opposite to said arm.

3. Apparatus as defined in claim 2, two laterally spaced positions on cooperation with an associated iliac post position, said brace being movable between positions each corresponding to one of the two positions of said perineal post.

4. Apparatus as defined in claim 1, said tube locating means comprising stops arranged for engagement by the periphery of the tube at circumferentially spaced points.

5. Apparatus as defined in claim 1, said pelvic support comprising a central portion as a'main pelvic support, and two auxiliary portions one on each side of said central portion, each auxiliary portion having means for mounting an iliac post thereon for lateral adjustment, said two auxiliary portions being connected together and mounted on said central portion for unitary movement relative thereto in the mesial direction.

6. Apparatus as defined in claim 1 including means for securing said pelvic support to an operating table of the type comprising body supports detachably mounted on the table by mating intercngaging members, said securing means comprising members on the lower side of said pelvic support in position to interengage with said mating members on the table for detachably mounting said pelvic support thereon.

7. Apparatus as defined in claim 1 including means for securing said pelvic support to an operating table of the type comprising side rails extending along and spaced from the edges of the table and mounted thereon by means of spacers extending outwardly from the table edges at spaced points,

said perineal post having said support, each for said securing means comprising hooks on the lower side of said pelvic support and arranged to hook over aligned spacers on opposite edges of the table, and stops on the lower side of said pelvic support arranged to fit snugly over other aligned spacers, said hooks and stops securing said pelvic support against movement relative to said table in either direction. 

1. Apparatus for use with a portable intensifier tube for the treatment of hip injuries and the like and comprising a pelvic support having a perineal post for restraining the pelvis against movement in the mesial direction and an iliac post for restraining it against transverse movement and capable of lateral adjustment according to the width of the pelvis, in which the improvement comprises means mounting said iliac post on said support for movement in the mesial direction relative to said perineal post to a position corresponding with the length of the pelvis, and intensifier tube locating means fixed to and projecting below said mounting means and movable mesially with said iliac post.
 2. Apparatus as defined in claim 1, including a supporting arm mounted on said perineal post and extending outwardly therefrom at a level above said pelvic support, a leg traction device depending from said arm at a point remote from said support, and a brace connected to said perineal post and extending therefrom in a direction approximately opposite to said arm.
 3. Apparatus as defined in claim 2, said perineal post having two laterally spaced positions on said support, each for cooperation with an associated iliac post position, said brace being movable between positions each corresponding to one of the two positions of said perineal post.
 4. Apparatus as defined in claim 1, said tube locating means comprising stops arranged for engagement by the periphery of the tube at circumferentially spaced points.
 5. Apparatus as defined in claim 1, said pelvic support comprising a central portion as a main pelvic support, and two auxiliary portions one on each side of said central portion, each auxiliary portion having means for mounting an iliac post thereon for lateral adjustment, said two auxiliary portions being connected together and mounted on said central portion for unitary movement relative thereto in the mesial direction.
 6. Apparatus as defined in claim 1 including means for securing said pelvic support to an operating table of the type comprising body supports detachably mounted on the table by mating interengaging members, said securing means comprising members on the lower side of said pelvic support in position to interengage with said mating members on the table for detachably mounting said pelvic support thereon.
 7. Apparatus as defined in claim 1 including means for securing said pelvic support to an operating table of the type comprising side rails extending along and spaced from the edges of the table and mounted thereon by means of spacers extending outwardly from the table edges at spaced points, said securing means comprising hooks on the lower side of said pelvic support and arranged to hook over aligned spacers on opposite edges of the table, and stops on the lower side of said pelvic support arranged to fit snugly over other aligned spacers, said hooks and stops securing said pelvic support against movement relative to said table in either direction. 